Abstract
Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusions: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.
Highlights
As global demographic trends shift towards increased proportions of older people in populations, disorders of ageing will become a substantial challenge for those providing health and social services [1,2].It is estimated that there are currently 33,000 people residing in nursing homes in Ireland [3]
Comparing the findings of this study with those reported in the literature, it appears that the prescribing rates of Antipsychotic medication (APM) in this sample is at the higher end of the scale, with prevalences ranges from as low as 12% to as high as 64% [36,37]
Risperidone is the only APM currently licensed for use in people with dementia in Ireland; this study found that it was used less than quetiapine and olanzapine
Summary
As global demographic trends shift towards increased proportions of older people in populations, disorders of ageing will become a substantial challenge for those providing health and social services [1,2].It is estimated that there are currently 33,000 people residing in nursing homes (longterm care facilities) in Ireland [3]. Approximately three-quarters of older people in Irish nursing homes are suffering from dementia [1]. Antipsychotic medications (APMs) are often used, mostly in an ‘off-licence’ capacity, to manage such symptoms [4,5,6]. Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Conclusions: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings
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